[Current approach to low back pain].
Despite advances in medical knowledge and available methods of treating spinal problems, the costs these problems generate are growing in a constant and exponential manner in western countries. Back pain is not different, commoner or more severe than in the past. This raises the question whether present-day management, which often runs counter to current scientific evidence, is appropriate. Practically speaking, so-called specific back pain is to be distinguished from nonspecific or common back pain. The former arises from a precise lesion (infectious, tumoral, inflammatory or traumatic), while the latter has no obvious underlying cause. Fortunately this preliminary differentiation is usually possible on the basis of the history and clinical workup alone. In this paper we deal solely with common back pain, as being by far the most frequent in everyday practice. Once a specific origin has been ruled out, the chief aim should be earliest possible resumption of the patient's normal activities. Various methods, embracing drug treatment, physiotherapy, and in appropriate cases ergotherapy, are available for this purpose. If this fails, the physician must react as rapidly as possible to prevent the condition becoming chronic. Regard should be had for the various psychosocial factors which interfere with the healing process, and a method should be adopted which is no longer based on the classic biomedical model but on a bio-psycho-social approach as proposed by Waddell. If necessary the patient should be referred to a specialist (rheumatologist, rehabilitation, orthopedist etc). Back pain is extremely widespread in the population at large and is a frequent reason why people consult a physician. On these grounds the primary care physician has a key role to play in the initial workup and also in the acute, subacute or chronic stage of the evolution. This review of the principles which should guide the practical approach to the back-pain patient is intended to aid the practitioner in his tasks of diagnosis and therapy.
Baumgartner
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Division de rhumatologie, HUG, Genève.
Vischer
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TL
D003131:Combined Modality Therapy; D003937:Diagnosis, Differential; D004185:Disability Evaluation; D006801:Humans; D017116:Low Back Pain / Q000209:etiology / Q000628:therapy*; D010147:Pain Measurement; D010348:Patient Care Team; D016896:Treatment Outcome
Approche actuelle des lombalgies.